eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Toxicology

Toxicity, Deadly in a Single Dose: Treatment & Medication

Author: Cynthia L Morris-Kukoski, PharmD, Clinical Assistant Professor, Department of Pharmacy and Occupational Medicine, Medical College of Virginia
Coauthor(s): Ann G Egland, MD, Consulting Staff, Department of Operational and Emergency Medicine, Walter Reed Army Medical Center
Contributor Information and Disclosures

Updated: Apr 23, 2009

Treatment

Medical Care

Immediate care should include the ABCs, plus 2 D 's: disability (ie, neurologic examination) and decontamination (ie, gastric decontamination). ABC procedures should follow standard Pediatric Advanced Life Support (PALS) and Advanced Pediatric Life Support (APLS) guidelines.

Perform gastric decontamination for all serious ingestions.

  • Perform gastric lavage in patients with life-threatening ingestions who present early (ie, generally, <1 h following ingestion). Beyond 1 hour, much of the toxin has already passed into the small intestine. Take special care to protect the patient's airway during gastric lavage. Protective measures may include intubation, particularly in comatose patients and patients with a decreased or absent gag reflex.
  • Gastric decontamination with activated charcoal is highly recommended. The dosage is 1 g/kg of body weight. Charcoal may be administered mixed with juice or soda if the child can drink from a cup. Administration often requires placing a nasogastric tube because the charcoal's gritty texture is not palatable to most children.
  • Whole bowel irrigation is effective in patients with certain ingestions who present too late for effective gastric lavage.

Consultations

  • Always consult the regional poison control center.
    • Locate the nearest US poison control center by contacting the American Association of Poison Control Centers at 1-800-222-1222.
    • In addition to providing advice on management and specific treatment or antidotes, poison control centers have on-call toxicologists available for physician consultations.
    • Data on toxic ingestions are compiled through reports to the poison control centers; these data improve treatment of future patients with similar ingestions.
  • The need for additional medical consultation depends on the nature of the ingestion and the toxicity of the substance.

Medication

  • Medical therapy is directed to the specific ingestion. Certain antidotes are well described for ingestion of a number of toxic substances.
  • Provide supportive therapy for patients with other ingestions, based on symptoms. (Specific antidotes for each of the previously mentioned toxic substances are beyond the scope of this article.)

More on Toxicity, Deadly in a Single Dose

Overview: Toxicity, Deadly in a Single Dose
Differential Diagnoses & Workup: Toxicity, Deadly in a Single Dose
Treatment & Medication: Toxicity, Deadly in a Single Dose
Follow-up: Toxicity, Deadly in a Single Dose
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Linakis JG. Amoxapine. Clin Toxicol Rev. 1988;10.

  2. Manoguerra AS. Tricyclic antidepressants. Crit Care Quarterly. 1982;43-51.

  3. Frommer DA, Kulig KW, Marx JA, Rumack B. Tricyclic antidepressant overdose. A review. JAMA. Jan 23-30 1987;257(4):521-6. [Medline].

  4. Litovitz TL, Felberg L, White S, Klein-Schwartz W. 1995 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1996;14(5):487-537. [Medline].

  5. Litovitz TL, Holm KC, Bailey KM, Schmitz BF. 1991 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1992;10(5):452-505. [Medline].

  6. Linden CH, Rumack BH, Strehlke C. Monoamine oxidase inhibitor overdose. Ann Emerg Med. Dec 1984;13(12):1137-44. [Medline].

  7. Olgun H, Yildirim ZK, Karacan M, Ceviz N. Clinical, electrocardiographic, and laboratory findings in children with amitriptyline intoxication. Pediatr Emerg Care. Mar 2009;25(3):170-3. [Medline].

  8. Shepard FM. Amoxapine intoxication in an infant: seizures arrested with diazepam. South Med J. Apr 1983;76(4):543-4. [Medline].

  9. Ellenhorn MJ, Barceloux DG. Medical Toxicology: Diagnosis and Treatment of Human Poisoning. New York, NY: Elsevier Science; 1988.

  10. McCarthy VP, Swabe GL. Chloroquine poisoning in a child. Pediatr Emerg Care. Jun 1996;12(3):207-9. [Medline].

  11. Litovitz TL, Martin TG, Schmitz B. 1986 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1987;5(5):405-45. [Medline].

  12. Kelly JC, Wasserman GS, Bernard WD, et al. Chloroquine poisoning in a child. Ann Emerg Med. Jan 1990;19(1):47-50. [Medline].

  13. [Best Evidence] Abdulla S, Oberholzer R, Juma O, et al. Safety and immunogenicity of RTS,S/AS02D malaria vaccine in infants. N Engl J Med. Dec 11 2008;359(24):2533-44. [Medline].

  14. Cann HM, Verhulst HL. Accidental ingestion and overdosage involving psychopharmacologic drugs. New Engl J Med. 1960;263:719-24.

  15. Litovitz TL, Felberg L, Soloway RA, et al. 1994 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1995;13(5):551-97. [Medline].

  16. Evers J, Buttner-Belz U. Fatal lorcainide poisoning. J Toxicol Clin Toxicol. 1995;33(2):157-9. [Medline].

  17. Litovitz TL, Bailey KM, Schmitz BF, et al. 1990 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1991;9(5):461-509. [Medline].

  18. Litovitz TL, Schmitz BF, Holm KC. 1988 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1989;7(5):495-545. [Medline].

  19. Baselt RC. Disposition of Toxic Drugs and Chemicals in Man. 5th ed. Foster City, CA: Chemical Toxicology Inst; 2000.

  20. Garrettson LK, McGee EB. Rapid onset of seizures following aspiration of viscous lidocaine. J Toxicol Clin Toxicol. 1992;30(3):413-22. [Medline].

  21. Lee DC, Greene T, Dougherty T, Pearigen P. Fatal nifedipine ingestions in children. J Emerg Med. Nov 2000;19(4):359-61. [Medline].

  22. Litovitz TL, Holm KC, Clancy C, et al. 1992 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1993;11(5):494-555. [Medline].

  23. Pearigen PD. Death from accidental nifedipine ingestion in a toddler. Vet Hum Toxicol. 1993;35:345.

  24. Bogusz MJ, Althof H, Mash DC. Ibogaine-associated death in a female heroin addict: forensic and toxicological aspects. J Forensic Sci. 1999.

  25. Litovitz TL, Klein-Schwartz W, Dyer KS, et al. 1997 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1998;16(5):443-97. [Medline].

  26. Sartori M, Pratt CM, Young JB. Torsade de Pointe. Malignant cardiac arrhythmia induced by amantadine poisoning. Am J Med. Aug 1984;77(2):388-91. [Medline].

  27. Mullins ME, Carrico EA, Horowitz BZ. Fatal cardiovascular collapse following acute colchicine ingestion. J Toxicol Clin Toxicol. 2000;38(1):51-4. [Medline].

  28. Granoff DM, McDaniel DB, Borkowf SP. Cardiorespiratory arrest following aspiration of chloral hydrate. Am J Dis Child. Aug 1971;122(2):170-1. [Medline].

  29. Nurse gives fatal overdose of codeine to child. Nurs Law Regan Rep. Aug 2008;49(3):2. [Medline].

  30. Rumack BH, Temple AR. Lomotil poisoning. Pediatrics. Apr 1974;53(4):495-500. [Medline].

  31. Glatstein M, Finkelstein Y, Scolnik D. Accidental methadone ingestion in an infant: case report and review of the literature. Pediatr Emerg Care. Feb 2009;25(2):109-11. [Medline].

  32. Litovitz TL, Schmitz BF, Matyunas N, Martin TG. 1987 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1988;6(5):479-515. [Medline].

  33. Smith AG, Margolis G. Camphor poisoning. Am J Path. 1954;30:857-69.

  34. Falk W, Hinrich R. Jacutin poisoning in childhood. Med Klin Wschr. 1957;42:1837.

  35. MacCready RA. Methyl salicylate poisoning: a report of five cases. New Engl J Med. 1943;228:155.

  36. Klys M, Wozniak K, Rojek S, Rzepecka-Wozniak E, Kowalski P. Ethanol-related death of a child: an unusual case report. Forensic Sci Int. Jul 18 2008;179(1):e1-4. [Medline].

  37. Mier RJ. Treatment of aniline poisoning with exchange transfusion. J Toxicol Clin Toxicol. 1988;26(5-6):357-64. [Medline].

  38. Trestrail JH. Criminal Poisonings: Investigational Guide for Law Enforcement, Toxicologists, Forensic Scientists, and Attorneys. Totowa, NJ: Humana Press; 2000.

  39. Locatelli C, Minoia C, Tonini M, Manzo L. Human toxicology of boron with special reference to boric acid poisoning. G Ital Med Lav. May-Jul 1987;9(3-4):141-6. [Medline].

  40. Wong LC, Heimbach MD, et al. Boric acid poisoning: report of 11 cases. Can Med Assoc J. 1964;90:1018-23.

  41. Cooper SW, Kimbrough RD. Acute dimethylnitrosamine poisoning outbreak. J Forensic Sci. Oct 1980;25(4):874-82. [Medline].

  42. Pond SM, Powell D, Allen TB. Fatal pontine infarction in a child who ingested diquat. Vet Hum Toxicol. 1983;25 (suppl 1):41-3.

  43. Litovitz TL, Smilkstein M, Felberg L, et al. 1996 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1997;15(5):447-500. [Medline].

  44. Litovitz TL, Klein-Schwartz W, Caravati EM, et al. 1998 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1999;17(5):435-87. [Medline].

  45. Sayre JW, Kaymakcalan S. Cyanide poisoning from apricot seed among children in central Turkey. New Engl J Med. 1964;270:1113-5.

  46. Lasch EE, El Shawa R. Multiple cases of cyanide poisoning by apricot kernels in children from Gaza. Pediatrics. 1981;68:5-7.

  47. Osterhoudt K. Pediatric emergency medicine: legal briefs. Pediatr Emerg Care. Oct 2008;24(10):700-4. [Medline].

  48. Anderson I. Nontoxic or minimally toxic household products. In: Olsen KR, ed. Poisoning and Drug Overdose. Simon and Schuster; 1999:239-42.

  49. Askenazi DJ, Goldstein SL, Chang IF. Management of a severe carbamazepine overdose using albumin-enhanced continuous venovenous hemodialysis. Pediatrics. Feb 2004;113(2):406-9. [Medline].

  50. Barrueto F, Wang-Flores HH, Howland MA, et al. Acute vitamin D intoxication in a child. Pediatrics. Sep 2005;116(3):e453-6. [Medline].

  51. Dempsey DA. Special considerations in pediatric patients. In: Olsen KR, ed. Poisoning and Drug Overdose. Simon and Schuster; 1999:55-8.

  52. Gosselin RE, Smith RP, Hodge HC. Clinical Toxicology of Commercial Products. 5th ed. Baltimore, Md: Williams and Wilkins;1984.

  53. Koren G. Medications which can kill a toddler with one tablet or teaspoonful. J Toxicol Clin Toxicol. 1993;31(3):407-13. [Medline].

  54. Liebelt EL, Shannon MW. Small doses, big problems: a selected review of highly toxic common medications. Pediatr Emerg Care. Oct 1993;9(5):292-7. [Medline].

  55. Litovitz T, Veltri JC. 1984 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1985;3(5):423-50. [Medline].

  56. Litovitz TL, Clark LR, Soloway RA. 1993 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1994;12(5):546-84. [Medline].

  57. Litovitz TL, Klein-Schwartz W, White S, et al. 1999 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2000;18(5):517-74. [Medline].

  58. Litovitz TL, Normann SA, Veltri JC. 1985 Annual Report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1986;4(5):427-58. [Medline].

  59. Litovitz TL, Schmitz BF, Bailey KM. 1989 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1990;8(5):394-442. [Medline].

  60. Loney PD, Walling AD. Chloroquine overdosage in infancy: a case report. Am Fam Physician. Jul 1989;40(1):164-6. [Medline].

  61. McFee RB, Mofenson HC, Caraccio TR. A nationwide survey of the management of unintentional-low dose tricyclic antidepressant ingestions involving asymptomatic children: implications for the development of an evidence-based clinical guideline. J Toxicol Clin Toxicol. 2000;38(1):15-9. [Medline].

  62. Nichols MH, King WD, James LP. Clonidine poisoning in Jefferson County, Alabama. Ann Emerg Med. Apr 1997;29(4):511-7. [Medline].

  63. Olympia RP, Wan E, Avner JR. The preparedness of schools to respond to emergencies in children: a national survey of school nurses. Pediatrics. Dec 2005;116(6):e738-45. [Medline].

  64. Veltri JC, Litovitz TL. 1983 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1984;2(5):420-43. [Medline].

  65. Wax PM, Cobaugh DJ, Lawrence RA. Should home ipecac-induced emesis be routinely recommended in the management of toxic berry ingestions?. Vet Hum Toxicol. Dec 1999;41(6):394-7. [Medline].

[ CLOSE WINDOW ]

Keywords

deadly in a single dose, accidental poisoning, toxic ingestions, medication overdose, drug overdose, fatal poisoning, overdose, single-dose poisoning, poisoning, ingestion, cosmetics, cleaning solutions, alcoholic beverages, unintentional ingestion, toxic ingestion, antidepressant ingestion, tricyclic antidepressant poisoning, desipramine poisoning, imipramine poisoning, monoamine oxidase inhibitor poisoning, amitriptyline poisoning, amoxapine poisoning, antimalarial drug poisoning, chloroquine poisoning, thioridazine poisoning, chlorpromazine poisoning, Clozaril poisoning

clonidine poisoning, lorcainide poisoning, quinidine poisoning, verapamil poisoning, disopyramide poisoning, lidocaine poisoning, nifedipine poisoning, ibogaine poisoning, LSD poisoning, nicotine poisoning, amantadine poisoning, colchicine poisoning, hypoglycemic agent poisoning, albuterol poisoning, chloral hydrate poisoning, codeine poisoning, methadone poisoning, iron poisoning, aspirin poisoning, pseudoephedrine poisoning, benzocaine poisoning, camphor poisoning, lindane poisoning, methanol poisoning, ethanol poisoning

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Cynthia L Morris-Kukoski, PharmD, Clinical Assistant Professor, Department of Pharmacy and Occupational Medicine, Medical College of Virginia
Cynthia L Morris-Kukoski, PharmD is a member of the following medical societies: American Academy of Clinical Toxicology
Disclosure: Nothing to disclose.

Coauthor(s)

Ann G Egland, MD, Consulting Staff, Department of Operational and Emergency Medicine, Walter Reed Army Medical Center
Ann G Egland, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Association of Military Surgeons of the US, Medical Society of Virginia, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

William T Zempsky, MD, Associate Director, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
William T Zempsky, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Jeffrey R Tucker, MD, Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
Jeffrey R Tucker, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Pediatrics, and Massachusetts Medical Society
Disclosure: Merck Salary Employment

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Maureen Strafford, MD, Arnold P Gold Foundation Associate Professor, Departments of Anesthesiology and Pediatrics, Tufts University and Tufts-New England Medical Center
Maureen Strafford, MD is a member of the following medical societies: American Medical Women's Association, American Pain Society, American Society of Anesthesiologists, International Anesthesia Research Society, Society for Education in Anesthesia, Society for Pediatric Anesthesia, and Society of Cardiovascular Anesthesiologists
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.